【摘要】目的 观察血液透析患者颈内静脉穿剌置管过程中心律失常的发生情况及相关影响因素。方法 选择2010年以来需要行颈内静脉穿剌插管的血液透析患者100例，在穿剌前、穿剌过程中应用心电监护仪观察患者心律失常情况并实时记录，收集患者一般资料及血气分析、电解质、肾功能情况，观察局部麻醉效果、穿剌是否顺利、穿剌导丝进入长度情况，分析心律失常与相关观察因素的关系。结果 29/100（29%）在穿剌过程中出现心律失常，心律失常的发生与导丝进入血管的长度有关（p<0.05），而与年龄、身高、局部麻醉效果、穿剌顺利与否及电解质、PH值、动脉氧分压、氧饱和度等无关。心律失常多表现为房性及室性早博，以房性早博多见。结论 血液透析患者颈内静脉穿剌插管过程中有较高的心律失常发生率，而心律失常的发生与导丝过深插入有关，避免过度插入导丝可减少心律失常的发生。

【Abstract】Objectives To observe the incidence and related influencing factors of arrhythmias during internal jugular vein catheterization in hemodialysis patients . Methods 100 cases underwent internal jugular central venus catheterization in our hospital from January 2010 to June 2012 were selected . Arrhythmias was recorded by the application of ECG monitor in the puncture process . The correlative data of patients , such as general information of patients、blood gas analysis、electrolytes、 renal function 、the effect of local anesthesia 、the succese rate of puncture and the length of insert guide wire ，were collected and analysed the relationship with arrhythmias . Results 29 cases of arrhythmia in the puncture process related with the length of insert guide wires (p <0.05), unrelated with age、 height、the effect of local anesthetic、 the succese rate of puncture、 electrolyte、PH value、PO2 and SPO2. The express of arrhythmias is atrial and ventricular premature beats, atrial premature beat mainly. Conclusions The incidence of arrhythmias during internal jugular vein catheterization in hemodialysis patients is more and related with the insertion of guide wires too deep , which to avoid over-insert the guide wire can reduce the incidence of arrhythmias.